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AND WE HAVE A CR! — The House will vote, likely Friday, on a CR that defunds Obamacare. This time leadership has the votes from their caucus for it, since the defunding language is part of the bill itself and not just attached as a rider. Once the CR goes over to the Senate, here’s how the whole thing could play out. The Senate could pass a version without the defunding language and send it back to the House. The House could then pass it with help from enough Democrats. Or it might not play out that easily. The POLITICO story: http://politi.co/18ceEXm

SENATE REPUBLICANS WAIT TO REACT — How did Senate Republicans react to the new House CR plan? Those who have been calling the loudest for defunding the law — Sens. Marco Rubio, Mike Lee and Ted Cruz — quickly praised it. Just about every other Republican is opting to stay quiet until the House actually passes it. The POLITICO story: http://politi.co/16gsB3L

ONE LAST OBAMACARE DRILLING BEFORE OCT. 1 — Expect blood to be shed. Republicans will get their last, best chance to grill the administration over Obamacare before the exchanges open, when Gary Cohen — director of the CMS office overseeing them — testifies before House Energy and Commerce today. If there are any problems or delays come Oct. 1, Republicans are likely to point back to Cohen’s testimony. The story: http://politico.pro/18bXIjH And Cohen’s testimony: http://1.usa.gov/1gyk4z5

Good morning and welcome to your Thursday-before-Friday edition of PULSE. What a busy health care week — is it almost over? Your PULSEr requests that you deliver all your pitches, tips and scoops wrapped around a hot cup of coffee; that way they’ll have a better chance of being included. And remember to follow me on Twitter: @pw_cunningham

“I wanna be mean and throw PULSE pies.”

WHAT HAPPENS TO IMPLEMENTATION IF GOV’T SHUTTERS? — It’s not coming around full circle, folks. An Obamacare-prompted government shutdown won’t really shut down Obamacare. You might want to read that sentence again. Or just check out our story, where we explain that the administration probably still has enough leeway to keep implementing the law even if the government closes down for a few days or weeks. But any longer than that could cause some problems. More here: http://politico.pro/19fxU5q

RSC UNVEILS REPEAL-AND-REPLACE PLAN — Well this has been a long time in coming. Republicans spent the first few years after the Affordable Care Act’s passage promising to replace it with their own reform plan. Now the Republican Study Committee has introduced such a bill — more than three years after Obamacare was passed, we should note. It contains a bunch of long-touted Republican ideas to reform health care — including HSA expansions and medical malpractice reform — but there’s no sign leadership will bring it to the floor. But RSC members are pretty enthused about it anyway. The Pro story: http://politico.pro/1eRrzW9 And a bill summary: http://1.usa.gov/1gyDhk5

WHITE HOUSE SUITS UP TO COMBAT FRAUD — The White House is stepping up its game to counter charges that the exchanges will invite fraud and jeopardize people’s privacy when they open in two weeks. High-level Cabinet and state officials met yesterday to discuss the issue. And the administration announced a call center where people can report fraud concerns and rapid response measures to address privacy threats. Colleague Jason Millman has the story: http://politi.co/1aU7soE

— At the other end of Pennsylvania Ave., Republicans kept up their “fraud” mantra as the House Oversight Committee released a report claiming the administration has admitted to potential weaknesses for fraud in the navigator program. http://1.usa.gov/1doH2sw

NEWS NUGGETS

… Get excited. The House will be back next week for sure — and they might even work through the weekend! Members will return next Wednesday and the House will remain in session until the spending fight is resolved, leadership says.

… What if it’s not resolved by October 1? The White House Office of Management and Budget is preparing for that scenario, kicking out a memo to federal agencies yesterday that asks them to prepare for the possibility of a government shutdown by the end of the month. http://1.usa.gov/1aRxUPC

HOUSE DEMS ON DEFUNDING: MEDICARE BENEFICIARIES WILL GET HURT — Ranking members Sandy Levin, Henry Waxman, Jim McDermott and Frank Pallone warned their Democratic colleagues late Wednesday that defunding the health care law will “wreak havoc” on Medicare — not just Obamacare. Their “dear colleague” letter says the defunding measure would bring Medicare payments to a "grinding halt," stop Medicare and Medicaid fraud prevention efforts and end the ACA's new Medicare benefits.

CMS PROJECTS ONE MORE YEAR OF SLOW HC SPENDING GROWTH — Expect health care spending to grow slowly for just one more year — by about 4 percent — and then jump up to 6.1 percent as more people gain coverage under Obamacare and, not surprisingly, get more health care. CMS actuaries released their annual projection yesterday and it contained mixed news for the future of health spending.

— On one hand, they expect costs to grow more slowly over the next 10 years than they did from 1990s leading up to the recession — a period of massive health care inflation. On the other hand, health care spending is still expected to grow faster than GDP despite the health law’s measures to rein in Medicare spending. The Pro story: http://politico.pro/1aU4eBy And the CMS projections, published in Health Affairs: http://bit.ly/156LLdc

** Pfizer Helpful Answers is a family of prescription assistance programs that provides eligible patients with their Pfizer prescriptions for free or at a savings, and offers reimbursement support services for select products. www.PHAHelps.com **

COLONOSCOPIES COULD REDUCE COLON CANCER BY 40 PERCENT — Forty percent of all colorectal cancers might be prevented if people regularly underwent colonoscopies, according to the Harvard School of Public Health. The study helps clear up uncertainty about how often people with average risk should undergo the procedure and supports existing guidelines to get a colonoscopy once every 10 years, researchers said. Published in the Journal of the American Medical Association: http://hvrd.me/1bsbkwj

NEVER TOO YOUNG FOR PLASTIC SURGERY — Also in JAMA today: It’s rarely too early to start cosmetic procedures, doctors Heather Hamilton and Kenneth Arndt write. Facial lines that make people appear as though they’re aging, tried or angry won’t form if treatments are started in younger patients. “Initiating regular treatment with a neuromodulator in an individuals’ 20s or 30s will have a dramatic effect on the appearance of the face as seen in the person’s 40s or 50s,” the two write. The viewpoint article: http://bit.ly/154Wj1v

CONGRESSIONAL GOP STILL SUSPICIOUS OF UNION EXEMPTION — Twenty-one Republican senators have sent a letter to the Office of Management and Budget urging against any rule that might give union members special access to premium subsidies. House Education and Workforce Republicans wrote a similar letter today, even though the administration said last week it won’t give unions any special treatment. The Senate letter: http://politico.pro/17KIrYk

MEDICAID, CHIP UNDER-ENROLLMENT LINKED TO REGION — Fewer eligible children are missing out on Medicaid and CHIP than a few years ago, but nearly all the states that are falling behind in enrolling them lay west of the Mississippi, according to an Urban Institute report. That points to a persistent challenge for public health advocates in key geographic areas. Pro’s Kyle Cheney reports: http://politico.pro/1gAbmjJ

NEW PARTNERSHIP TO FIGHT PRESCRIPTION DRUG ABUSE — The American Medical Association, CVS Caremark Corporation and three other groups have formed a new nonprofit partnership they’re calling the Alliance to Prevent the Abuse of Medicines. Through it, they aim to advance policy solutions to prescription drug abuse. Details: http://bit.ly/1dsxEEu

PRO EDUCATION IS NOW LIVE: The first of three new policy sections coming to POLITICO Pro this fall is officially live. Pro Education offers subscribers access to high-impact, high-velocity coverage of education, delivering exclusive real-time news and analysis and an early-bird edition of Morning Education. Interested? Email info@politicopro.com or call (703) 341-4600. Read more about the launch here: http://politi.co/1eL4Afu

WHAT WE’RE READING, By Brett Norman

In a closed door meeting about whether the government should pay a share of Congress’ health insurance premiums, Rep. Phil Gingrey had little sympathy for young staffers’ financial worries. He said “in a few years they can just go to K Street and make $500,000 a year. Meanwhile, I’m stuck here making $172,000,” Jonathan Strong reports at the National Review Online. http://bit.ly/19fSIcV

Individuals who get insurance through smaller employers pay about twice as much in out-of-pocket expenses each year as those who get insurance from larger ones, and the consumer protections in the health care law aren’t going to fix that, the Wall Street Journal reports. http://on.wsj.com/18aVZNB

Expect to see more lesser-known insurers on the exchanges than the large legacy insurers that are concerned about signing up too many sick people, also from the WSJ. http://on.wsj.com/1dqpT1M

The Huffington Post reports that senior House GOP aides are “beside themselves” over Sen. Ted Cruz’s statement Wednesday that the Senate Democrats would likely succeed in stripping Obamacare defunding language from the CR, at which point “House Republicans must stand their ground.” http://huff.to/1gB5eaZ

Americans have the wrong ideas about what’s driving Medicare’s financial problem — fraud and government mismanagement top the list — but those factors “pale in comparison” to the ones that really are, Scott Hensley reports at NPR’s Shots blog. http://n.pr/1aUKHRA

The Cleveland Clinic will cut $330 million from its $6 billion annual budget “to prepare for” Obamacare, according to Reuters story that does not explain why the belt-tightening might be needed. http://reut.rs/19gdZTK

The JP Morgan analyst who predicted an imminent announcement that exchange enrollment would be delayed back-pedaled the report yesterday after a vehement denial from HHS and “conversations with more sources,” Reuters reports. http://reut.rs/19fvtjb

Fox News reports that Oregon is running a “30-second acid-trip-style ad” to recruit people to its new health exchange. http://fxn.ws/19fdAlR

** A message from Pfizer Helpful Answers: For more than 25 years, Pfizer has been a trusted resource for patients by providing prescription assistance to millions of Americans in need. In the last five years (2008-2012), Pfizer Helpful Answers helped more than 3.4 million uninsured and underinsured patients get access to more than 39 million Pfizer prescriptions, equaling more than $6.5 billion. As health care evolves in 2013 and beyond, Pfizer will continue to adapt the program to meet the changing needs of patients.

Pfizer Helpful Answers is a joint program of Pfizer Inc and the Pfizer Patient Assistance Foundation™. **